Contribuições dos aplicativos móveis para o atendimento pré-hospitalar: revisão integrativa / Contribuciones de las aplicaciones móviles para la atención prehospitalaria: revisión integradora / Contributions of mobile applications to pre-hospital care: integrative review

Resumo Objetivo Analisar as contribuições científicas dos aplicativos móveis desenvolvidos para o atendimento pré-hospitalar. Métodos Estudo de revisão integrativa da literatura; as bases de dados usadas foram Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Biblioteca Digital Brasileira de Teses e Dissertações e ProQuest Dissertations & Theses Global; (período de 2017-2022), incluindo todas as categorias de artigo, (com resumo e textos completos, disponíveis com acesso gratuito) nos idiomas português, inglês ou espanhol, contendo as palavras-chave "Assistência Pré-Hospitalar", "Atendimento Pré-Hospitalar", "Serviços Pré-Hospitalares", "Atendimento de Emergência Pré-Hospitalar", "Enfermagem", "Aplicativos móveis", "Aplicativos de Software Portáteis", "Apps Móveis", nos títulos e/ou resumos. Dois pesquisadores aplicaram os critérios de elegibilidade dos estudos e coletaram os dados a partir do instrumento elaborado previamente. Resultados De um total de 944 estudos, 07 foram selecionados para avaliação. Os aplicativos móveis desenvolvidos para a área de atendimento pré-hospitalar são ferramentas tecnológicas que contribuíram para a triagem, primeiros socorros pediátricos, segurança do paciente, preparação de medicações durante parada cardíaca, qualidade da ressuscitação cardiopulmonar, comunicação entre equipe de emergência e registro eletrônico de enfermagem. Conclusão Os estudos apontaram as potencialidades referentes à utilização dos aplicativos móveis no atendimento pré-hospitalar, contribuindo especialmente para melhoria da segurança dos pacientes e a qualidade do cuidado prestado nas situações de urgência e emergência pré-hospitalar. A otimização do tempo de assistência e do diagnóstico precoce foram também mostrados como contribuições dos aplicativos na assistência, além de alertar para os detalhes que podem passar despercebidos.

Resumen Objetivo Analizar las contribuciones científicas de las aplicaciones móviles para la atención prehospitalaria. Métodos Estudio de revisión integradora de la literatura. Las bases de datos utilizadas fueron Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Biblioteca Digital Brasileira de Teses e Dissertações y ProQuest Dissertations & Theses Global (período de 2017-2022). Se incluyeron todas las categorías de artículos, con resumen y texto completo, disponibles con acceso gratuito, en los idiomas portugués, inglés o español, que contuvieran las palabras clave "Asistencia Prehospitalaria", "Atención Prehospitalaria", "Servicios Prehospitalarios", "Atención de Emergencia Prehospitalaria", "Enfermería", "Aplicaciones Móviles", "Aplicaciones de Software Portátiles", "Apps Móviles", en el título o resumen. Dos investigadores aplicaron los criterios de elegibilidad de los estudios y recopilaron los datos a partir de un instrumento elaborado previamente. Resultados De un total de 944 estudios, se seleccionaron siete para evaluación. Las aplicaciones móviles desarrolladas para el área de atención prehospitalaria son herramientas tecnológicas que contribuyeron para la clasificación, los primeros auxilios pediátricos, la seguridad del paciente, la preparación de medicaciones durante paro cardíaco, la calidad de la reanimación cardiopulmonar, la comunicación entre los equipos de emergencia y el registro electrónico de enfermería. Conclusión Los estudios señalaron el potencial referente a la utilización de las aplicaciones móviles en la atención prehospitalaria, lo que contribuye especialmente a la mejora de la seguridad del paciente y a la calidad del cuidado ofrecido en las situaciones de urgencia y emergencia prehospitalaria. La optimización del tiempo de la atención y el diagnóstico temprano también demostraron ser contribuciones de las aplicaciones de asistencia, además de advertir detalles que pueden pasar desapercibidos.

Abstract Objective Analyze the scientific contribution of mobile applications developed for pre-hospital care. Methods Integrative literature review study; the databases used were the following: Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Brazilian Digital Library of Theses and Dissertations, and ProQuest Dissertations & Theses Global; (period 2017-2022), including all article categories (with abstract and full texts available with free access) in Portuguese, English, or Spanish, containing the keywords "Pre-Hospital Assistance", "Pre-Hospital Care", "Pre-Hospital Services", "Pre-Hospital Emergency Care", "Nursing", "Mobile applications", "Portable Software Applications", and "Mobile Apps" in titles and/or abstracts. Two researchers applied the eligibility criteria of the studies and collected data using a previously prepared instrument. Results From a total of 944 studies, seven were selected for evaluation. Mobile applications developed for the pre-hospital care area are technological tools that have contributed to triage, pediatric first aid, patient safety, preparation of medications during cardiac arrest, quality of cardiopulmonary resuscitation, and communication between the emergency team and the electronic nursing record. Conclusions The studies highlighted the potential related to the use of mobile applications in pre-hospital care, contributing especially to improving patient safety and the quality of care provided in pre-hospital urgency and emergencies. The optimization of assistance and early diagnosis times was also shown as a contribution of applications to assistance, in addition to alerting to details that may be unnoticed.

Influence Of Hulling And Storage Conditions On Maintaining Coffee Quality.

Storage is important in the coffee post-harvest. Determining the maximum period that coffee can remain storaged is important aiming to reduce losses in quality and, consequently, allow the producer to achieve maximum profitability. The aim was to determine the suitable storage period for natural and fully washed coffees, under different conditions. Beans were dried to 11% moisture content after dry processing (natural coffee, dry cherry coffee) and wet processing (parchment coffee, fully washed). Before storage, part of the coffee was hulled and part was not. The coffee was stored under refrigerated air (10ºC and 50% relative humidity) or in an environment at 25ºC. In the periods of 0, 3, 6, and 12 months, samples were taken for sensory, electrical conductivity and tetrazolium evaluation. Refrigerated environment favors conservation of sensory and physiological quality of the natural hulled coffee beans and fully washed coffee. Hulled beans of natural and fully washed coffee stored under refrigerated conditions have the initial quality conserved for up to 12 months and in non-controlled environmental, for up to 3 months. Mechanical damage caused by hulling, associated with the lack of tissue fruit parts, contributes to reduction hulled coffee quality in storage, regardless of the processing.

Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure / Rigidez vascular e envelhecimento arterial saudável em pacientes idosos com pressão arterial ideal

ABSTRACT Introduction: Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA). Objective: To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal. Methods: A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication). Results: In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)]. Conclusion: Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.

RESUMO Introdução: A velocidade da onda de pulso é usada para diagnosticar a rigidez arterial central (RAC) e quantificar o envelhecimento vascular saudável (EVS). Objetivo: Avaliar a RAC e o EVS em pacientes idosos com níveis pressóricos sistêmicos classificados como ideais/normais. Métodos: Um total de 102 pacientes sem comorbidades e com pressão sistólica (PS) < 120 mmHg e pressão diastólica (PD) < 80 mmHg foram selecionados do banco de dados EVOPIU (Estudo da Velocidade de Onda de Pulso em Idosos em área Urbana no Brasil). Foram avaliadas a velocidade da onda de pulso carotídeo-femoral (VOPcf) e as pressões central e periférica em todos os pacientes. Os pacientes foram divididos em quatro grupos: G1: (n = 19; com VOPcf < 7,6 m/s; sem medicação), G2 (n = 26; VOPcf ≥ 7,6 m/s; sem medicação), G3 (n = 25; VOPcf < 7,6 m/s com medicação anti-hipertensiva), e G4 (n = 32; VOPcf ≥ 7,6 m/s com medicação anti-hipertensiva). Resultados: Em nossa amostra, 56,7% dos pacientes apresentaram VOPcf ≥ 7,6 m/s. A pressão sistólica central no G1 [99 (10) mmHg] foi inferior à encontrada nos outros três grupos [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0,05)]. Conclusão: Pessoas idosas com pressão arterial ideal não necessariamente têm EVS e podem apresentar valores de VOPcf próximos aos limites estabelecidos para o diagnóstico de RAC.

Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure.

INTRODUCTION: Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA). OBJECTIVE: To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal. METHODS: A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication). RESULTS: In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)]. CONCLUSION: Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.

Desempenho acadêmico no primeiro e terceiro anos escolares: um estudo preditivo / Academic performance in first and third grades: a predictive study / Rendimiento académico en el primer y tercer grados: un estudio predictivo

Os anos iniciais do ensino fundamental são essenciais para o aprimoramento de habilidades sociais e aca-dêmicas. Este estudo teve como objetivos predizer o desempenho acadêmico no terceiro ano do ensino fundamental com base em estressores escolares, habilidades sociais e problemas de comportamento e desempenho acadêmico no primeiro ano e verificar mudanças e estabilidades das variáveis investigadas do primeiro para o terceiro ano e associações. Participaram do estudo 43 alunos do primeiro ano, com média de idade de 6 anos, e do terceiro ano, com uma média de 8 anos de idade, e oito professores do primeiro ano e sete do terceiro ano. A pesquisa foi realizada em escolas públicas do interior paulista. Adotaram-se os seguintes instrumentos: Provinha Brasil, Inventário de Estressores Escolares e Social Skills Rating System. Estressores escolares e desempenho acadêmico no primeiro ano foram preditores do desempenho acadê-mico no terceiro. Os alunos apresentaram ganhos em desempenho acadêmico, habilidades sociais e redu-ção de problemas de comportamento, com associações significativas entre as variáveis. Estudos preditivos contribuem para elaboração de programas de prevenção.

The early years of elementary school are essential for improving social and academic skills. This study aimed to predict academic performance in the 3rd year of elementary school based on school stressors, social skills and behavior problems, and academic performance in the 1st year and verify changes and stability of the investigated variables from the 1st to the 3rd year and associations. The study included 43 1st-year students with an average age of 6 years and 3rd-year 8-year-olds, and eight 1st-year teachers and seven 3rd-year teachers. The research was carried out in public schools in the interior of São Paulo. The following instruments were adopted: Provinha Brasil, School Stressors Inventory, and Social Skills Rating System. School stressors and academic performance in the 1st year were predictors of academic performance in the 3rd Students showed gains in academic performance, social skills, and reduction in behavior problems, with significant associations between variables. Predictive studies contribute to the development of prevention programs

Los primeros años de la escuela primaria son esenciales para mejorar las habilidades sociales y académicas. Este estudio tuvo como objetivo predecir el rendimiento académico en el tercer año de la escuela primaria a partir de los estresores escolares, las habilidades sociales y los problemas de conducta y el rendimiento académico en el primer año, y verificar los cambios y la estabilidad de las variables investigadas del primer al tercer año y asociaciones. El estudio incluyó a 43 estudiantes del primer año con una edad promedio de 6 años y del tercero de 8 años, y ocho maestros de primer año y siete maestros de tercer año. La investi-gación se llevó a cabo en escuelas públicas del interior de São Paulo. Fueron adoptados los siguientes instrumentos: Provinha Brasil, Inventario de Estresores Escolares y Social Skills Rating System. Los estresores escolares y el rendimiento académico en el primer año fueron predictores del rendimiento académico en el tercero. Los estudiantes mostraron mejoras en el rendimiento académico, las habilidades sociales y la re-ducción del comportamiento problemático, con asociaciones significativas entre las variables. Los estudios predictivos contribuyen al desarrollo de programas de prevención.

A rights-based approach to public health emergencies: The case of the 'More Rights, Less Zika' campaign in Brazil.

During health emergencies, the security agenda tends to impose itself over the human rights agenda. That happened when Brazil became the Zika-related PHEIC epicentre in 2016. While the federal government promoted a 'war against the mosquito' Aedes aegypti, some social actors emphasised the social determinants of health and women's rights. This article presents the United Nations Population Fund (UNFPA) led campaign 'More Rights, Less Zika' as a consistent example of the positive effects the coordination between global and local actors might have on health initiatives. We conducted field research in Recife, Northeast of Brazil, one of the campaign's target cities, where we interviewed main local actors. The campaign focussed on disseminating women's sexual and reproductive rights as an alternative to the strategy of the federal government, primarily focussed on controlling the vector, postponing pregnancies, and the use of repellent. Despite its scale limitations, the campaign demonstrates that a right-based approach can contribute to increasing the security of communities during health emergencies. The case also suggests that coordinating global actors' actions with local actors improves the quality of global health initiatives, which is particularly important when a conservative agenda opposing women's rights gains leverage in Brazil and other States.

Late Embryogenesis Abundant Protein-Client Protein Interactions.

The intrinsically disordered proteins belonging to the LATE EMBRYOGENESIS ABUNDANT protein (LEAP) family have been ascribed a protective function over an array of intracellular components. We focus on how LEAPs may protect a stress-susceptible proteome. These examples include instances of LEAPs providing a shield molecule function, possibly by instigating liquid-liquid phase separations. Some LEAPs bind directly to their client proteins, exerting a holdase-type chaperonin function. Finally, instances of LEAP-client protein interactions have been documented, where the LEAP modulates (interferes with) the function of the client protein, acting as a surreptitious rheostat of cellular homeostasis. From the examples identified to date, it is apparent that client protein modulation also serves to mitigate stress. While some LEAPs can physically bind and protect client proteins, some apparently bind to assist the degradation of the client proteins with which they associate. Documented instances of LEAP-client protein binding, even in the absence of stress, brings to the fore the necessity of identifying how the LEAPs are degraded post-stress to render them innocuous, a first step in understanding how the cell regulates their abundance.

Association between diabetes mellitus and central arterial stiffness in elderly patients with systemic arterial hypertension.

BACKGROUND: Aging increases the risk of chronic diseases, especially cardiovascular diseases, leading to changes in cardiovascular anatomy and physiology even in the absence of other comorbidities. Numerous cardiovascular risk factors (CVRFs), such as diabetes mellitus (DM) and systemic arterial hypertension (SAH), can modify the functional and structural properties of large vessels, increasing arterial stiffness. OBJECTIVE: To determine whether elderly patients with hypertension with DM have greater central arterial stiffness than elderly patients with SAH without DM. METHODS: The Study of Pulse Wave Velocity in the Elderly in an Urban Area in Brazil (EVOPIU) included 1,192 patients aged ≥ 60 years who underwent applanation tonometry (AT) to evaluate carotid-femoral pulse wave velocity (cfPWV). From this database, 1,133 patients were selected from 6 groups: NDN (nondiabetic normotensives; n: 127); DN (diabetic normotensives; n: 64); NDCH (nondiabetic controlled hypertensives; n: 168); DCH (diabetic controlled hypertensives; n: 275); NDH (nondiabetic hypertensives; n: 217) and DH (diabetic hypertensives; n: 282). All groups underwent AT to obtain cfPWV and central and peripheral arterial pressures. RESULTS: The pulse wave velocities found were as follows: NDN vs DN (8.9 ± 0.2 m/s vs 9.4 ± 0.2; P = .103); NDCH vs DCH (9.0 ± 0.2 m/s vs. 9.6 ± 0.1 m/s; P= .04) and NDH vs DH (9.2 ± 0.1 m/s vs. 9.6 ± 0.1 m/s; P= .045). When the diabetic groups were compared, there were no differences in cfPWV values, and the same occurred when the nondiabetic groups were compared. CONCLUSIONS: Elderly patients with diabetes and hypertension have greater central arterial stiffness than patients without diabetes and hypertension, regardless of systemic blood pressure control. The central arterial stiffness caused by vascular aging seems to be a common factor among all the studied groups.

Análise do conceito de conforto: contribuições para o diagnóstico de Disposição para Conforto melhorado / Análisis del concepto de confort: contribuciones al diagnóstico de la Disposición para mejorar el confort / Analysis of the concept of comfort: Contributions to the diagnosis of Readiness for enhanced comfort

RESUMO Objetivos Analisar o conceito de conforto à luz do modelo de análise conceitual evolucionista de Rodgers e incorporar elementos da análise conceitual na estrutura do diagnóstico de enfermagem "Disposição para conforto melhorado" (00183). Métodos Estudo de análise de conceito com aplicação das sete etapas do modelo evolucionário de Rodgers, sendo orientado para a condução da fase 1 de validação do diagnóstico de enfermagem. O material para análise foi obtido com a estratégia de revisão integrativa da literatura. Resultados e discussão Apresenta-se perspectiva histórico-desenvolvimental do conceito de quatro períodos temporais. Evidencia atributos, antecedentes, consequentes, termos substitutos e definições conceituais obtidos da decomposição conceitual, utilizando-os para a atualização dos componentes da "Disposição para conforto melhorado" (00183). Conclusão e implicações para a prática A abordagem evolucionária de análise do conceito mostrou ser apropriada para clarificar o conceito de conforto, dela emergindo tanto uma perspectiva orientada para o bem-estar quanto para as alterações do desconforto. A análise do conceito de conforto no método evolucionário contribuiu para a atualização do diagnóstico de enfermagem em tela. Os resultados obtidos fornecem elementos para a realização de futuros estudos de validação diagnóstica por experts e de validação clínica o que impacta positivamente no uso da linguagem diagnóstica.

RESUMEN Objetivos Analizar el concepto de confort a la luz del modelo de análisis conceptual evolutivo de Rodgers e incorporar elementos de análisis conceptual en el marco del diagnóstico enfermero "Disposición para mejorar el confort" (00183). Métodos Estudio de análisis conceptual con aplicación de los siete pasos del modelo evolutivo de Rodgers, orientado a realizar la fase 1 de validación del diagnóstico enfermero. El material para el análisis se obtuvo con la estrategia de revisión integradora de la literatura. Resultados y discusión Se presenta una perspectiva histórica y de desarrollo del concepto de cuatro períodos temporales. Destaca los atributos, antecedentes, consecuencias, términos sustitutos y definiciones conceptuales obtenidas de la descomposición conceptual, usándolos para actualizar los componentes de la " Disposición para mejorar el confort" (00183). Conclusión e implicaciones para la práctica se ha demostrado que el enfoque evolutivo del análisis de conceptos es apropiado para aclarar el concepto de confort desde una perspectiva orientada hacia el bienestar hasta los cambios de la incomodidad. El análisis del concepto de confort en el método evolutivo contribuyó a la actualización del diagnóstico enfermero. Estos resultados proporcionan elementos para futuros estudios de validación diagnóstica por expertos y validación clínica, lo que impacta positivamente el uso del lenguaje diagnóstico.

ABSTRACT Objectives To analyze the concept of comfort in light of Rodgers' conceptual evolutionary analysis model and to incorporate elements of conceptual analysis into the framework of the nursing diagnosis "Readiness for enhanced comfort" (00183). Methods Concept analysis with the application of the seven steps of Rodgers' evolutionary model, oriented to the conduction of phase 1 of the validation of the nursing diagnosis. The material for analysis was obtained through the strategy of integrative review of the literature. Results and discussion A historical-developmental perspective of the concept with four temporal periods is presented. It reveals attributes, antecedents, consequences, substitute terms and conceptual definitions obtained from conceptual decomposition and we used them to update the components of the diagnosis "Readiness for enhanced comfort" (00183). Conclusion and implications for practice The evolutionary approach to concept analysis proved to be appropriate to clarify the concept of comfort, and a well-being perspective and a discomfort perspective emerged from it. An analysis of the concept of comfort in accordance with the evolutionary method contributed to the update of the nursing diagnosis. The results provide elements for future diagnostic validation studies conducted by experts and clinical validation studies, which has a positive impact on the use of diagnostic language.

Ethanol dehydrogenative reactions catalyzed by copper supported on porous Al-Mg mixed oxides.

Mixed aluminum and magnesium oxides (AlMgO) prepared by means of an emulsion-mediated sol-gel method was impregnated with copper nitrate solution and used in the ethanol dehydrogenative reactions to produce acetaldehyde and ethyl acetate. The emulsified system allowed to obtain a macro-mesoporous support that resulted in an outstanding dispersion of copper. The porous catalyst was about 3 times more active than the non-porous counterpart, due to the formation on the support's surface of Cu0 together with the more active Cu+ species. In fact, the simultaneous presence of Cu+ and Cu0 were advantageous for the catalytic performance, as the turnover frequencies, were 122 and 166 h-1 for the non-porous reference catalyst and for the porous one, respectively. Both catalysts deactivated due to copper particles sintering, however the porous one deactivated less, as a consequence of the better dispersion of the Cu species on the macro and mesoporous support. Acetaldehyde was the main product, however by increasing the contact time by 6.6 times, the conversion of ethanol on the non-porous catalyst reached about 90% with a selectivity to ethyl acetate of 20% by means of the coupling reaction of ethanol and acetaldehyde. The selectivity to ethyl acetate was favoured on an increased support/copper interface that is given by larger copper particles.

Two new usnic acid derivatives from the endophytic fungus Mycosphaerella sp.

The endophytic fungus Mycosphaerella sp. (UFMGCB2032) was isolated from the healthy leaves of Eugenia bimarginata, a plant from the Brazilian savanna. Two novel usnic acid derivatives, mycousfuranine (1) and mycousnicdiol (2), were isolated from the ethyl acetate extract, and their structure was elucidated by NMR and MS analyses. Compounds 1 and 2 exhibited moderate antifungal activities against Cryptococcus neoformans and Cryptococcus gattii, each with minimum inhibitory concentration values of 50.0 µg/mL and 250.0 µg/mL, respectively.

Apoio em saúde: forças em relação / Health support: strengths in relation to / Apoyo en salud: fuerzas en relación / Soutien à la santé: forces en relation avec

Pretende-se, neste artigo, problematizar os modos de se produzir apoio no Sistema Único de Saúde (SUS), situando o apoio como um agir político entre forças em relação, que pode (ou não) ampliar e favorecer a capacidade de gestão e produção do cuidado local e regional. Destaca-se, no cenário do SUS, um campo de permanente disputa na relação entre os municípios e a gestão estadual, que convoca ao debate no campo da micropolítica do trabalho. Assim, para estudar o apoio, acompanhei o mundo do trabalho dos articuladores de uma regional da Secretaria Estadual de Saúde de São Paulo (SES/SP). Entendida como uma pesquisa-intervenção e, no sentido de acompanhar processos, a cartografia possibilitou produzir relações no campo (registradas em diário de campo), processar os efeitos do campo e construir um certo plano de analisadores, sendo: clínica e cuidado em saúde, micropolítica ativa, forças das experimentações do apoio, necessidade de fabricação de atores-apoiadores e uso de ferramentas-conceitos para o apoio em saúde. Como resultados, apontamos para implicações políticas dos atores-apoiadores, implicações entre forças que se organizam e desorganizam permanentemente e que podem provocar outros agenciamentos na produção de redes de alianças e potências do cuidado em saúde.

This paper aims at problematizing the means of support on Public Healthcare System (SUS, Sistema Único de Saúde), considering support as a political action between related elements, which may (or may not) expand and benefit management and production capabilities of local and regional healthcare. In the environment of SUS, an ongoing struggle is present in the relationship between counties and state management, thus inviting a debate towards the field of work micropolitics. Therefore, to study support, I have accompanied the workspace of planners from a São Paulo State Bureau of Healthcare (SES/SP, Secretaria Estadual de Saúde de São Paulo) regional office. Extended as an interventional study and, with the intention of accompanying processes, this cartography enabled the creation field relations (recorded in field diary), understanding of the effects of onfield work, and construction of an analysis plan, namely: health clinic and care, active micropolitics, experimentation impact in support, need to assemble supporters, and use of conceptual tools in healthcare support. We then present as results the political implications from supporters, implications between elements which permanently coordinate and uncoordinate themselves, and have the ability to initiate other operations in creating networks and care capabilities in health.

Se pretende, en este artículo, problematizar los modos de producir apoyo en el Sistema Único de Salud (SUS, Sistema Único de Saúde), situando el apoyo como un actuar político entre fuerzas en relación, que puede (o no) ampliar y favorecer la capacidad de gestión y producción del cuidado local y regional. Se destaca, en el escenario del SUS, un campo de permanente disputa en la relación entre los municipios y la gestión estadual, que convoca al debate en el campo de la micropolítica del trabajo. Así, para estudiar el apoyo, acompañé el mundo del trabajo de los articuladores de una regional de la Secretaría Estatal de Salud de São Paulo (SES/SP, Secretaria Estadual de Saúde de São Paulo). La cartografía posibilitó producir relaciones en el campo (registradas en diario de campo), procesar los efectos del campo y construir un cierto plan de analizadores, siendo: clínica y cuidado en salud, entendida como una investigaciónintervención y, en el sentido de acompañar procesos, micropolítica activa, fuerzas de las experimentaciones del apoyo, necesidad de fabricación de actores-apoyadores y uso de herramientas-conceptos para el apoyo en salud. Como resultados, apuntamos a las implicaciones políticas de los actores-apoyadores, implicaciones entre fuerzas que se organizan y desorganizan permanentemente y que pueden provocar otros agenciamientos en la producción de redes de alianzas y potencias del cuidado en salud.

Dans cet article, nous avons l'intention de problématiser les manières de produire un soutien dans le système de santé unifié (SUS, Sistema Único de Saúde), en le plaçant comme une action politique entre des forces en relation, qui peuvent ou non s'étendre et favoriser les capacités de gestion et de production, soins locaux et régionaux. Il se distingue, dans le scénario du SUS, un champ de conflit permanent dans la relation entre les municipalités et la direction de l'État, qui appelle au débat dans le domaine de la micropolitique du travail. Ainsi, pour étudier le soutien, j'ai suivi le monde du travail des articulateurs d'un responsable régional du Département de la santé de São Paulo (SES/SP, Secretaria Estadual de Saúde de São Paulo). Elle a été comprise comme une recherche d'intervention et, au sens de processus de suivi, la cartographie a permis de créer des relations de terrain (enregistré dans le journal de terrain), de traiter les effets du terrain et de construire un certain plan d'analyseurs: clinique et santé. micropolitique active, soutien des forces d'expérimentation, nécessité de fabriquer des acteurssupporters et utilisation d'outils-concepts pour le soutien à la santé. En conséquence, nous soulignons les implications politiques des acteurssupporters, les implications parmi les forces organisées et désorganisées de manière permanente et qui peuvent provoquer d'autres assemblages dans la production de réseaux d'alliances et de pouvoirs de soins de santé.

Biofilms of Candida albicans and Streptococcus sanguinis and their susceptibility to antimicrobial effects of photodynamic inactivation.

This study evaluated the effects of photodynamic inactivation (PDI) on single and multi-species biofilms, compounds by Candida albicans and Streptococcus sanguinis. Biofilms were formed, on microplate of 96 wells, by suspensions of C. albicans (ATCC 18804) and S. sanguinis (ATCC 7073) adjusted in 107 cells/mL, followed by incubation of 48 h (with 5% CO2). The effects of the photosensitizer erythrosine (ER) at 400 µM for 5 min and green light-emitting diode (LED - 532 ±â€¯10 nm) for 3 min, alone and conjugated, were evaluated. After normality test, results was analysed by Tukey´s test (P < 0.05). PDI group promoted reductions of 1.07 and 0.39 log10, respectively, in biofilms of C. albicans alone and in association with S. sanguinis. Biofilms of S. sanguinis alone were more sensitive, with reduction of 4.48 log10. When in association with the yeast, S. sanguinis have a decrease of 2.67 log10. SEM analysis revealed a decrease in bacterial and fungal structures of biofilms treated with PDI. In conclusion PDI promoted significant microbial reductions in both species of microorganisms grown on mixed biofilms. This study is one of the pioneers to evaluate the antimicrobial action of PDI on biofilms of S. sanguinis and C. albicans, demonstrating a way to control these microorganisms of clinical importance.

Functional and structural characterization of an ECF-type ABC transporter for vitamin B12.

Vitamin B12 (cobalamin) is the most complex B-type vitamin and is synthetized exclusively in a limited number of prokaryotes. Its biologically active variants contain rare organometallic bonds, which are used by enzymes in a variety of central metabolic pathways such as L-methionine synthesis and ribonucleotide reduction. Although its biosynthesis and role as co-factor are well understood, knowledge about uptake of cobalamin by prokaryotic auxotrophs is scarce. Here, we characterize a cobalamin-specific ECF-type ABC transporter from Lactobacillus delbrueckii, ECF-CbrT, and demonstrate that it mediates the specific, ATP-dependent uptake of cobalamin. We solved the crystal structure of ECF-CbrT in an apo conformation to 3.4 Å resolution. Comparison with the ECF transporter for folate (ECF-FolT2) from the same organism, reveals how the identical ECF module adjusts to interact with the different substrate binding proteins FolT2 and CbrT. ECF-CbrT is unrelated to the well-characterized B12 transporter BtuCDF, but their biochemical features indicate functional convergence.

Photodynamic inactivation in the expression of the Candida albicans genes ALS3, HWP1, BCR1, TEC1, CPH1, and EFG1 in biofilms.

The objective of this study was to evaluate the effects of photodynamic inactivation (PDI) on Candida albicans biofilms, evaluating its effects on gene expression of ALS3, HWP1, BCR1, TEC1, CPH1, and EFG1 by yeast. Three samples of C. albicans were used in this study: a clinical sample from a patient with HIV (39S), a clinical sample from a patient with denture stomatitis lesion (Ca30), and a standard strain ATCC 18804. The quantification of gene expression was related to the production of those genes in the samples referred above using quantitative polymerase chain reaction (qPCR) assay in real time. The photosensitizer methylene blue at 300 uM and erythrosine at 400 uM, sensitized with low-power laser (visible red, 660 nm) and green LED (532 nm), respectively, were used for PDI. Four groups of each sample and PDI protocol were evaluated: (a) P+L+: sensitization with the photosensitizer and irradiation with light, (b) P+L-: only treatment with the photosensitizer, (c) P-L+: only irradiation with light, and (d) P-L-: without sensitization with the dye and absence of light. The results were analyzed by t test, with a significance level of 5%. The photodynamic inactivation was able to reduce the expression of all genes for both treatments, laser and LED. The fold-decrease for the genes ALS3, HWP1, BCR1, TEC1, CPH1, and EFG1 were 0.73, 0.39, 0.77, 0.71, 0.67, and 0.60 for laser, respectively, and 0.66, 0.61, .050, 0.43, 0.54, and 0.66 for LED, respectively. It could be concluded that PDI showed a reduction in the expression of C. albicans genes, suggesting its virulence decrease.

HIV-associated opsoclonus-myoclonus-ataxia syndrome: early infection, immune reconstitution syndrome or secondary to other diseases? Case report and literature review

Opsoclonus-myoclonus-ataxia (OMA) syndrome is a debilitating autoimmune neurological disorder. Post-infectious opsoclonus-myoclonus-ataxia syndrome has been described with varying bacterial, spirochetal, and viral infections including several patients with HIV. However, specific immunopathological mechanisms that may lead to opsoclonus-myoclonus in HIV-positive patients are unknown.We report a case of HIV-associated opsoclonus-myoclonus and early HIV infection. A review of published literature shows opsoclonus-myoclonus can occur during early infection, in immune reconstitution syndrome or in association with other infections, especially tuberculosis

HIV-associated opsoclonus-myoclonus-ataxia syndrome: early infection, immune reconstitution syndrome or secondary to other diseases? Case report and literature review.

Opsoclonus-myoclonus-ataxia (OMA) syndrome is a debilitating autoimmune neurological disorder. Post-infectious opsoclonus-myoclonus-ataxia syndrome has been described with varying bacterial, spirochetal, and viral infections including several patients with HIV. However, specific immunopathological mechanisms that may lead to opsoclonus-myoclonus in HIV-positive patients are unknown.We report a case of HIV-associated opsoclonus-myoclonus and early HIV infection. A review of published literature shows opsoclonus-myoclonus can occur during early infection, in immune reconstitution syndrome or in association with other infections, especially tuberculosis.

Gestão estadual na saúde e articuladores: forças em relação / State Management in Health and Articulators forces in relation to

Introdução: A articulação interfederativa é um importante desafio, que impõe tensões ao desenho da regionalização no Sistema Único de Saúde (SUS) no Brasil. União, estados e municípios enfrentam contextos diversos na produção de políticas, organização de serviços e práticas de saúde em cada âmbito. As Secretarias de Estado da Saúde (SES) ainda buscam seu papel no acompanhamento aos municípios e às regiões de saúde. A relação entre a SES e os municípios nos espaços regionais é marcada por diferentes jogos de forças e disputas de projetos que possibilitam diversos conflitos e acordos. A SES/SP propôs articuladores nos seus 17 Departamentos Regionais de Saúde nas áreas de Atenção Básica, Humanização e de Saúde da Mulher. Objetivo: acompanhar, estudar e problematizar os modos de se produzir a gestão estadual em saúde a partir do trabalho dos articuladores no que se refere às relações que constroem com municípios e regiões de saúde no Estado de São Paulo. Metodologia: o modo de produzir a pesquisa propôs um campo relacional e político que possibilitou acompanhar experiências, incluindo a do pesquisador-trabalhador. Uma cartografia de jogo de forças e afectabilidades nos encontros e planos em disputa que contribuiu para uma análise micropolítica do trabalho do articulador e de algumas perspectivas da gestão estadual. Resultados: o combate na pesquisa foi com questões sobre a gestão estadual e com questões sobre a prática do apoio em saúde. Os encontros acompanhados indicaram forças em relação, ora com ações mais produtoras de regularidades e capturas do trabalho vivo, ora com ações de cooperação e (re)invenção dos encontros entre gestores, trabalhadores e usuários. Conclusões: mesmo sem aposta da gestão central da SES/SP, são possíveis produções de apoio, pois todos governam e há forças ativas nos encontros. Ao romper com forças de dominação, mesmo que em pequenos acontecimentos, há a possibilidade de todo trabalhador-gestor, na dimensão da micropolítica ativa, exercer potências afirmativas de pensar e agir coletivamente na saúde, ainda que em cenários de sucateamentos políticos de gestão que perduram e se ampliam

Introduction: The interfederative articulation is an important challenge and tension in the drawing of regionalization in the Sistema Único de Saúde (SUS) in Brazil. Union, states and municipalities face diverse contexts in the production of policies, services organization and health practices in each scope. The Secretarias de Estado da Saúde (SES), the provincial governments in health, still seek their role in the follow-up to the counties and health regions. The relationship between SES and the counties at the regional spaces is defined by different power games and disputes of projects that enable several conflicts and deals. The SES/SP proposed articulators in yours 17 Regional Health Departments at the areas of Basic Attention, Humanization and Woman Health. Objective: follow-up, study and to problematize the ways of producing the state health management by means of the articulators work regarding the support to the health regions in the State of São Paulo. Methodology: the way of producing the research proposed a relational and political field that made possible follow-up experiences, including the worker-researcher. A game map of forces and affect in the meetings and disputed plans that contributes for a micropolitical analysis of articulators work and some perspectives of state management. Results: the struggle in the research was with questions about the state management and with questions about the support practices in health. The process follow up indicated strengths in relation, sometimes producing regularities and captures of live work, sometimes producing cooperation and (re)invention of meetings among managers, workers and users. Conclusions: Although central management of SES/SP doesn´t sustain cooperative relations, it is possible to produce glimpses, perspectives of support as, in health, everybody plays as active stakeholders and there are active strengths in the meetings. On breaking up with the forces of domination, even in small events, there it is possible for every worker-manager, in the active micropolitical dimension, to exercise affirmative powers of thinking and acting collectively in health, even in scenarios of political scrapping of management that last and extend

Pre-sarcopenia and bone mineral density in adults submitted to hematopoietic stem cell transplantation

Abstract Background: The aim of this study was to evaluate the prevalence of pre-sarcopenia and bone mineral density after hematopoietic stem cell transplantation. Methods: The study group consisted of over 18-year-old patients who had been submitted to allogeneic transplantation at least one year previously. Patients and healthy controls were matched by sex, ethnic background, age, and body mass index. Body composition and bone mineral density were measured by dual-energy X-ray absorptiometry. A 24-h food recall and food frequency survey were performed. The biochemical evaluation included calcium, parathormone and vitamin D. Eighty-seven patients (52 men; age: 37.2 ± 12.7 years; body mass index: 25 ± 4.5 kg/m2) were compared to 68 controls [31 men; age 35.4 ± 15.5 years (p = 0.467); body mass index 25.05 ± 3.7 kg/m2 (p = 0.927)]. Results: There was no significant difference in the dietary intake between patients and controls. The mean levels of vitamin D were 23.5 ± 10.3 ng/mL; 29 patients (41.0%) had insufficient and 26 (37.14%) deficient levels. A higher prevalence of reduced bone mineral density was observed in 24 patients (25%) compared to 12 controls (19.1% - p < 0.001). Pre-sarcopenia was diagnosed in 14 (14.4%) patients and none of the controls (p = 0.05). There was a higher prevalence of pre-sarcopenia (66%) in patients with grades III and IV compared to those with grades 0-II graft-versus-host disease (10.9%) (p = 0.004). Conclusion: patients submitted to transplantation had a higher prevalence of pre-sarcopenia and greater changes in bone mineral density compared to controls; the severity of graft-versus-host disease had an impact on the prevalence of pre-sarcopenia.

Pre-sarcopenia and bone mineral density in adults submitted to hematopoietic stem cell transplantation.

BACKGROUND: The aim of this study was to evaluate the prevalence of pre-sarcopenia and bone mineral density after hematopoietic stem cell transplantation. METHODS: The study group consisted of over 18-year-old patients who had been submitted to allogeneic transplantation at least one year previously. Patients and healthy controls were matched by sex, ethnic background, age, and body mass index. Body composition and bone mineral density were measured by dual-energy X-ray absorptiometry. A 24-h food recall and food frequency survey were performed. The biochemical evaluation included calcium, parathormone and vitamin D. Eighty-seven patients (52 men; age: 37.2±12.7 years; body mass index: 25±4.5kg/m2) were compared to 68 controls [31 men; age 35.4±15.5 years (p=0.467); body mass index 25.05±3.7kg/m2 (p=0.927)]. RESULTS: There was no significant difference in the dietary intake between patients and controls. The mean levels of vitamin D were 23.5±10.3ng/mL; 29 patients (41.0%) had insufficient and 26 (37.14%) deficient levels. A higher prevalence of reduced bone mineral density was observed in 24 patients (25%) compared to 12 controls (19.1% - p<0.001). Pre-sarcopenia was diagnosed in 14 (14.4%) patients and none of the controls (p=0.05). There was a higher prevalence of pre-sarcopenia (66%) in patients with grades III and IV compared to those with grades 0-II graft-versus-host disease (10.9%) (p=0.004). CONCLUSION: patients submitted to transplantation had a higher prevalence of pre-sarcopenia and greater changes in bone mineral density compared to controls; the severity of graft-versus-host disease had an impact on the prevalence of pre-sarcopenia.